急性肺栓塞（PE）诊治进展课件.pptVIP

急性肺栓塞（PE）诊治进展 基本概念 肺栓塞（pulmonary embolism,PE):是以各种栓子堵塞肺动脉系统为其发病原因的一组疾病或临床综合征的总称，包括肺血栓栓塞、脂肪栓塞、羊水栓塞、空气栓塞等。 肺血栓栓塞症（pulmonary thromboembolism, PTE):是指来源于静脉系统或右心血栓堵塞肺动脉或其分枝引起肺循环障碍的临床和病理生理综合征。 肺动脉血栓形成（pulmonary thrombosis）指肺动脉病变基础上（如肺血管炎、白塞氏病等）原位血栓形成，多见于肺小动脉，并非外周静脉血栓脱落所致，临床不易与肺栓塞相鉴别。 基本概念 深静脉血栓形成（deep venous thrombosis,DVT): 纤维蛋白、血小板、红细胞等血液成份在深静脉管腔内形成凝血块（血栓）。 静脉血栓栓塞症（venous thrombolism,VTE): PTE 和DVT是同一疾病过程中两个不同阶段， 统称为VTE. 从PTE到VTE PTE: pulmonary thromboembolism 肺血栓栓塞症 DVT: deep venous thrombosis 深静脉血栓形成 VTE: venous thromboembolism 静脉血栓栓塞症 VTE = PTE + DVT 强调VTE观 概念的转变与防治策略的选择 The incidence of physical signs 96% have tachypnea (respiratory rate 16/min) 58% develop rales 53% have an accentuated second heart sound 44% have tachycardia (heart rate 100/min) 43% have fever (temperature 37.8°C) 36% have diaphoresis 34% have an S 3 or S 4 gallop 32% have clinical signs and symptoms suggesting thrombophlebitis 24% have lower extremity edema 23% have a cardiac murmur 19% have cyanosis Original Geneva Score Age: 60 – 79 years (1 point) 80+ years (2 points) Previous DVT or PE (2 points) Recent surgery within 4 weeks (3 points) Heart rate 100 beats per minute (1 point) PaCO2 (partial pressure of CO2 in arterial blood): 35mmHg (2 points) 35 - 39mmHg (1 point) PaO2 (partial pressure of O2 in arterial blood): 49mmHg (4 points) 49 - 59mmHg (3 points) 60 - 71mmHg (2 points) 72 - 82mmHg (1 point) Revised Geneva Score Age 65 years or over (1 point) Previous DVT or PE (3 points) Surgery or fracture within 1 month (2 points) Active malignant condition (2 points) Unilateral lower limb pain (3 points) Haemoptysis (2 points) Heart rate: 75 to 94 beats per minute (3 points) 95 or more beats per minute (5 points) Pain on deep palpation of lower limb and unilateral oedema (4 points) Revised Geneva Score interpretation The score obtained relates to probability of PE: 0 - 3 points indic